Graduated: 2019
NPI: 1619517406
Practice Locations (2)
THE WALLACE MEDICAL CONCERN
18633 SE STARK ST
PORTLAND, OR 972335468
5034891760
THE WALLACE MEDICAL CONCERN
18633 SE STARK ST, SUITE 401
PORTLAND, OR 972335468
5034891760
Source: CMS National Downloadable File, September 2026.